"If man did not exist as a world-spanning receptive
realm of perception, if he were not engaged in this capacity, nothing at
all could exist. 'Being,' in its traditional usage, means 'presence' and
'persistence.' To achieve presence, and thereby being, an entity requires
some sort of open realm in which presence and persistence can take place.
Thus an open realm of perception like that of human existence is the one
being that makes being possible."
- Medard Boss

ON MEDARD BOSS

A psychoanalyst and physician inspired by the
existential-phenomenological
philosophy of Martin
Heidegger, Medard Boss set himself the ambitious task of humanizing
medicine and psychology from a new existential foundation. Boss, a student
of Freud, did not want
to do away with the valuable insights of medicine and psychiatry, but rather
felt the call to show how the current, modern theoretical pressupositions
of medicine and psychiatry were built on faulty theoretical grounds. Not
so much as an application of, but rather from a working out of the ground
of Heidegger's ontology, Boss felt that psychology and medicine would allow
for a place of theory and practice which does a greater justice to the
human.

Boss announces this new "paradigm" for medicine
and psychiatry as a Daseinsanalysis to differentiate it from Psychoanalysis.
However, it should not be misconstrued that Boss' Daseinsanalysis is antithetical
to Freud's practice of psychoanalysis; rather, his criticisms are aimed
at Freud's meta-psychology. Boss highlights the inherent tension in Freud
between his human-science practice and his natural science theory involving
"strenous mental acrobatics" due to an "overstepping" of "what was actually
experienced and perceived." Boss' struggle with Freud's meta-psychology
led him to explore Heidegger's philosophy and, as Paul J. Stern writes:
"Not only did Heidegger's ontology propose a reconstructed image of man
that boldly abolished long entrenched antinomies, but this image also proved
to be amazingly relevant and applicable directly to psychiatry and psychology."

How so? Heidegger's magnum opus, Being &
Time, provides a method and ground by which to explore the ontological
structure of the human kind of being, which he called Dasein (translated
as 'there-being'). Through a hermeneutic-phenomenological method, Heidegger
provides a provisional articulation of the 'essential' structures of human
existence, which he called "existentials." That is, for Heidegger, there
are certain givens of existence, such as sociality, time, space, others,
things, etc. How we understand these givens of existence changes historically,
yet this foundational structure (or ontology) of human beings constitutes
the basis for the dynamic and unfolding direction of the human being's
becoming.

Boss' method is what could be called an 'ontic'
articulation of Heidegger's 'ontology.' Boss is using Heidegger's method
in order to explore psychology and psychiatry and to lay out a human anthropology,
whereas Heidegger is concerned with the question of Being, ontology. Thus,
Boss' method is phenomenological: it gives a primacy to perception by allowing
things to show themselves from themselves in the very way in which they
show themselves. Implied here is that Freud's meta-psychology (and any
other theory of human existence) is inevitably a second-order abstraction
from our lived engagement in-the-world. Boss then, like Heidegger, aims
toward a hermeneutic (interpretive) articulation of this lived engagement
in our "average everyday" world as human beings.

Stern writes:"...Heidegger's so-called existentials provided
the basis for a new psychodiagnostic scheme. More importantly, his Daseinanalytik
directly challenged and led to a radical redefinition of such fundamental
notions as reality and reality-testing, dispensed with whatever philosophical
respectibility such concepts as the unconscious or repression might have
acquired, and highlighted the sterility with which various chronic preoccupations
had previously been framed--such as the body-mind question. Heidegger's
trenchant philosophical analysis made explicit by Boss, ended up by leveling,
to a large degree, traditional distinctions betwen psychic and organic
illness. The leveling of the traditional partitions between psychiatry
and general medicine was the inevitable corollary." (xiii)

Boss' first book, Meaning and Content of Sexual
Perversions, was published in 1947 and focused on case studies of sexual
deviants. In this book, Boss describes the sexual deviant as suffering
a constricted existence by which he or she is unable to participate in
a genuine loving of another human being--a love that is as much spiritual
as sensual--due to self-absorption. In his second book, Boss explored the
phenomenon of dreaming. From a Heideggerian place, Boss develops a method
of dream analysis which allows the dream to reveal its own meaning and,
as such, the method avoids, Boss felt, the kind of interpretive violence
that can be done in the name of 'analysis.' Most importantly, Boss apprached
dreams with the utmost care and regard, giving the dream-world as much
ontological significance as waking life; that is, the dream is viewed by
Boss as a being-in-the-world on equal footing with the day-world of waking
consciousness.

Perhaps one of the most significant aspects of
Boss' work is a re-conception of the role of the physician. As Stern writes:
"it was no longer enough for the doctor to be an expert repairman of bodily
or psychic dysfunctions. The Daseinanalytic healer is called upon to deal
with the existential limitations and deficiencies of which, in the Dasienanalytic
canon, individual diseases, both psychic and organic, are--or, at least,
may be, symptomatic." (xvi) Boss is particularly relevant today as the
framer of an alternative paradigm for medicine apart from the cold and
inhuman effiency and means-end rationality of the essembly-line approach
to medicine which has become economically (and ideologically?) motivated
by the rising power of HMOs.

Boss' prelimary work on sexual deviancy, dreams,
and the role of the physician culminated in his first global and systematic
attempt to re-work Freudian psychoanalysis from an existential-phenological
perspective. Boss' Psychoanalysis and Daseinsanalysis (1957) particularly
focused on the problem of "transference" in Freud's meta-psychology. In
general, Boss persuasively argued, through concrete descriptions of case
studies with his own patients in psychotherapy, that Freud's empirical
observations, made thematic in his case studies, are inconsistent and abstracted
from in his theory. As always, Boss holds a tension between his reverance
and indebtedness to Freud while attempting to overcome the inconsistencies
in Freud's meta-psychology. Boss suggests that Freud is, in some sense,
a closet 'existentialist' whose practice reveals a profound ability to
attend to empirical phenomena, which nevertheless, in the theoretical articulation
of these phenomena, become veiled by the metaphysical prejudices of his
culture. The theory of "transference" is a case in point.

Freud's meta-psychological theory of transference
assumes that feelings are thing-like, isolated and detachable phenomena
which can be transferred from one person (object) to another. Boss, however,
understands feelings as "attunement" in the Heideggerian sense; that is,
as a mooded openness to the world with-others. Thus, Boss is able to talk
about transference in a way which makes much more theoretical sense and
is more true to the concrete experience of "transference" in psychotherapy.
In order to understand feelings in such a concrete, existential sense,
it is necessary to begin with a new foundation for understanding human
existence as a whole. It is this foundation which Boss fully articulates
in his Existential
Foundations of Medicine and Psychology.

Boss writes:"We declare that only man exists. This is not
to say that material, inorganic nature and nonhuman beings--animals and
plants--are in any sense unreal, insubstantial, or illusory beccause they
do not so exist. We merely state that the reality of these nonhuman realms
differs from that of human existence, whose primary characteristic is Dasein
(literally "being-the-there")...Man as man is present...in a manner wholly
different from...inanimate things." (xxix)

Medicine, deriving its foundations from Descartes,
begins with an understanding of a split between subject and object and
between mind and body. As such, medicine approaches the human body as a
thing subject to causal, mechanistic processes like inanimate objects in
nature. For Boss, however, the human being is precisely not a thing, and
thus the body cannot be understood as a thing. Rather, the body is primarily
an existential-body, the means by which we are a being-in-the-world and
"body-forth" our possibilities. It is as bodies that we exist in existential
space. But this space is not the res extensa of Descartes; it is
not mere geometrical space. "Human beings," writes Boss, "are, as
an open, clear realm of perception, so essentially spatial that they dwell
from the beginning with whatever is accessible to perception, and
in a way suited to the meaning they perceive." (90) That is, for human
beings, spatiality is part of the ontological structure of the human being,
without which our being-in-the-world would not be possible. This is a spatiality
which is an openness to significance, to how things matter to us. As such,
spatiality is meaningful and consists of the context of significance which
is the world.

As Being-there (Dasein), the human being
is always with the things of the world, "actually at the place where
the thing is present." (92) In this sense, the body is not a thing, but
the existential center by which things can presence to us in our world-openness.
Yet, in my experience, I am not simply here at my body; rather, it is my
body which is the openness to the "there" which is the meaningful world
of perception. Things, unlike my body, gather a world of meaning. They
gather together the contextual signficance of the world as mattering to
me as a human being. Thus, too, the thing is not a representation in my
head: "When we visualize something, we establish a relationship to the
thing itself, not to some mere subjective representation of it inside us."
(92) In my experience, I am at the thing, I am in-the-world as a embodied
being.

While the human being is spatial, it is equally
and just as importantly temporally structured. But the way we live time
must be distinguished from clock time. "A watch," writes Boss, "can only
tell us how much time it is, how much time has passed, or
how
much time must still pass before something will occur. These statements
are related not to time itself but only to its measurement or calculation."
(93) Like space, time is always significant, meaningful; "time is always
time for something." (94) Thus, time is not simply a succession
of "now-points" along a straight line. Time is part of the very structure
of human existence; it is "the basis of our dwelling in the world." To
"have" time is to be open to the past, present and future as the world-spanning
opennness of human existence. "Having" time, I have it "in such a way that
I am expectant of which is to come, aware of what is present, and retentive
of what has been." (101)

Space and time, as such, make possible and yet
are equiprimordial with human bodyhood. Yet, while natural science views
the human body as some self-contained material thing, by doing so it "disregards
everything that is specifically human about human bodyhood." (100) The
human body, unlike a thing, is not limited like the material borders of
inanimate objects. Rather, as a world-openness, human embodiment is an
opening onto things "there" in the world, while things are self-contained
and have no experience what-so-ever. The human body does not end at the
skin, but existentially opens onto a world of possibilities which are significant.
"The borders of my bodyhood coincide with those of my openness to the world,"
writes Boss. "They are in fact at any given time identical, though they
are always changing with the fluid expansion and contraction of my relationships
to the world." (103)

It is by virtue of the existentials of space,
time and body that Boss reveals the equiprimordial existential of human
co-existence in a shared world. As spatial-temporal, embodied being-in-the-world,
human beings can be together--with each other--"jointly and inherently
dwelling in the same relationship to the common objects of their shared
world." (106) Human beings are radically social; always already a being-with.
Even loneliness or being alone can only be understood first as a condition
of our primordial structure as primarily a being-with-others, without which
being alone or lonely would not be possible. The human being, therefore,
is not first an individual and then social by means of an additive process;
rather, the human being is radically social from the very beginning and
individuality is secondary to this primordial sociality.

To return to the subject of feelings or moods,
Boss shows that the openess of human beingness is always attuned or mooded
in one way or another. Boss writes: "The prevailing attunement is at any
given time the condition of our openness for perceiving and dealing with
what we encounter; the pitch at which our existence is vibrating. What
we call moods, feelings, affects, emotions, and states are the concrete
modes in which the possibilities for being open are fulfilled. They are
at the same time the modes in which this perceptive openness can be narrowed,
distorted, or closed off." (110) How one is attuned, then, opens up certain
possibilities of relatedness to the world, while closing off others.

As always attuned to the world as a bodying-forth
of one's temporal-spatial being-in-the-world, human beings can also be
understood as radically historical. "Whether he is aware of it or not,"
writes Boss, "every human being dwells in tradition and history. Human
memory is this constant dwelling in tradition. It constitutes that fundamental
human characteristic of historicity." (119) The human being is its history,
and that history is there in one's embodied relationship to the world as
a particular kind of openness. History opens up possibilities and provides
a direction to the becoming of our lives at the same time that it forecloses
possibililities and restricts one's possibilities. And this directionality
is at any given moment always already an extension from birth to death.

"Death is an unsurpassable limit of human existence,"
writes Boss (119). Primarily, however, human beings flee from death and
the awareness of our mortality. But in our confrontation with death and
our morality, we discover the "relationship" which "is the basis for all
feelings of reverance, fear, awe, wonder, sorrow, and deference in the
face of something greater and more powerful." (120). Boss even suggests
that "the most dignified human relationship to death" involves keeping
it--as a possibility rather than an actuality--constantly in awareness
without fleeing from it. As Boss writes: "Only such a being-unto-death
can guarantee the precondition that the Dasein be able to free itself from
its absorption in, its submission and surrender of itself to the things
and relationships of everyday livingn and to return to itself." (121) Such
a recognition brings the human being back to his responsibility for his
existence. This is not simply a inward withdrawal from the world--far from
it. Rather, this responsible awareness of death as the ultimate possibility
for human existence frees the human being to be with others in a genuine
way.

From this foundation--based on the existentials
described above--Boss is able to articulate an understanding of medicine
and psychology which gives priority to the freedom of the human being to
be itself. By freedom, Boss does not mean a freedom to have all the possibilites,
for we are finite and limited by our factical history and death. Yet within
these finite possibilities, we are free to be who we are and to take responsibility
for who we are in the world with others and alongside things that matter.
Psychotherapy comes into play in cases in which people suffer from "pathological
deficiencies of freedom," who, while constricted, still retain a degree
of freedom, but a freedom which includes a suffering from constrictedness.
The therapist, in this regard, provides the client with a space to free
up this constricted existence in order to discover previously foreclosed
possibilities of being in the world.

With this existential foundation, Boss is able
to describe concretely a more human medicine and psychology which overcomes
the mind-body split, the subject-object dichotomy, and physiological reductionism
and allows for a freedom within limits--all of which, based on the pressupositions
of modern medicine and psychology, were previously impossible.

As Boss said:"A new vision and understanding of something
demands a new way of talking about it, for the old terminology gets in
the way of this effort. Stubbornly entrenched behind the words coined by
a particular conceptual orientation are its secrete prejudices. Any attempt
to open out an adequately human vista onto the phenomena of undisturbed
existence must include a critique of the most important idea of traditional
biology, physiology, and psychology." (125)